HSG Foresees Major Potential Financial Impact on Employed Physician Networks and Medical Groups from 2021 Proposed Medicare Physician Fee Schedule
Healthcare Consultants Urge Hospitals and Health Systems to Start Planning for Impact on Physician Compensation and Medicare Payments for Professional Services.
Neal D. Barker, Partner at HSG, a national healthcare consulting firm is the author of “Changes to the 2021 Medicare Physician Fee Schedule Could Have Major Impact on Physician Compensation.” The article is available for download at the website, hsgadvisors.com.
Louisville, KY, Oct. 21, 2020 (GLOBE NEWSWIRE) — HSG, a national healthcare consulting firm, has published a detailed evaluation of the Centers for Medicare & Medicaid Services (CMS) 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule, which is scheduled to take effect on January 1, 2021, if approved in the Final Rule. The advisors at HSG believe the proposed changes may have a significant potential impact on physician compensation and urge healthcare executives to start planning for these proposed changes. The agency’s Fee Schedule changes cover everything from Work Relative Value Unit (wRVU) values for specific Current Procedural Terminology (CPT) codes to changes in the scope of practice policies for Advanced Practice Providers (APPs) and changes related to CMS’s quality payment program.
With more than a 10% decrease in the MPFS conversion factor, services that do not have any change in Relative Value Unit values will see a decrease in Medicare payment at the projected rate of more than 10%. The decreased reimbursement will not be fully offset by any reimbursement increases realized through the Quality Payment Program paths. Changes related to outpatient and office evaluation and management (E&M) service code determinations and requirements, along with permanent and temporary additions to telehealth codes, will add to compensation complications. The redefined E&M code selection criteria will now be driven by medical decision making (MDM) or time spent alone – with no direct contribution by history and/or exam elements.
“Assuming these changes are included when the Final Rule is published in early December, many industry organizations, consultancies, and provider advocacy groups are projecting significant increases in provider productivity-based compensation if the providers’ E&M profile remains unchanged,” explained Neal Barker, Partner at HSG. “Ultimately, hospitals and health systems may face a situation in which payments from Medicare will decrease while their physician compensation requirements will significantly increase based on the widespread use of wRVU-based compensation models for employed physicians and APPs.”
As the roll-out date for the new Fee Schedule grows closer, HSG is working with healthcare systems to help them gain an understanding of the potential impact on the network. Then HSG works with the organization to build a model to address changes to wRVU targets and bonus conversion factors that yield productive compensation levels that are financially sustainable and uphold fair market value and commercial reasonableness. Coincident with the compensation impact review, HSG conducts a series of provider
In an effort to slow cost growth and improve health care quality, Medicare has in recent years developed a number of new ways to pay for and provide health care, and has been testing them through pilot programs in facilities and communities across the country. These test programs give heath care providers both financial incentives and new flexibility to change how they deliver care, with the goal of improving coordination and quality, reducing unnecessary or duplicative services, and focusing on outcomes important to patients and their families.
This report highlights and describes in detail seven innovative programs that represent a variety of approaches and span a wide range of Medicare services. In selecting these promising innovations, the authors examined the evidence of their effects on cost and quality-of-care. They also considered other implications, including effects on individuals’ access to care, and on patients’ and family caregivers’ experiences. The innovations are sorted into three groups based on evidence for their potential benefits.
In addition to describing these seven innovations, the report includes a discussion of each program’s results: its scope and scale, and its effects so far on cost and quality. The discussions review available evidence from Medicare as well as other government agencies and outside experts, covering specific dollar amount cost savings as well as quality measures, (e.g., hospitalizations, readmissions, emergency department visits), and other findings from patients and clinicians when available. The discussions consider potential benefits to consumers and to Medicare were any of these programs to be scaled up; they also identify potential negative effects and areas for potential improvement.
Transformation in health care takes time. However, with careful evaluation, development, and expansion of successful models, innovative Medicare payment and delivery models, like those reviewed here, have the potential to help control Medicare spending while improving the quality of care.
The seven innovations sorted into three groups based on evidence for potential benefits are as follows:
Group One: Innovations with demonstrated evidence of success that could yield broad benefits to both consumers and the Medicare program if expanded.
Innovation #1 – Independence at Home: Comprehensive In-Home Primary Care for People with High Needs
Independence at Home is testing whether providing comprehensive primary care services at home for individuals with very high health care needs leads to better health outcomes, improved patient and caregiver satisfaction, and lower Medicare costs. In theory, home-based care allows clinicians to provide coordinated, comprehensive care that reduces the risk for costly preventable hospital stays, readmissions, or emergency department visits.
Innovation #2 – Community-based Care Transitions Program: Partnerships between Community-Based Organizations and Hospitals to Improve Post-Hospital Transitions
The Affordable Care Act (ACA) mandated this program with the goal of reducing hospital readmissions, which are often caused by factors beyond the walls of the hospital (e.g., medication errors or not receiving sufficient assistance with activities of daily living). This initiative, now completed, relied heavily on community-based organizations with experience connecting patients and family caregivers to community support services (e.g., Meals on Wheels, transportation). Most of the
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Many seniors who enroll in Medicare are shocked to learn that it’s far from free. In fact, there are many out-of-pocket costs you’ll incur on Medicare, from premiums to deductibles to copays, which can really put a strain on your retirement budget.
The good news? With a few strategic moves, you can slash your spending, preserve your savings, and eliminate one major source of financial worry. Here are a few easy ways to keep your Medicare costs to a minimum.
1. Sign up on time
You’re entitled to Medicare coverage at age 65, and your initial enrollment window begins three months before the month of your 65th birthday and ends three months after that month. If you don’t sign up for Medicare on time, you’ll not only risk a gap in coverage, but also potentially end up paying more for Part B, which covers outpatient care. Specifically, you’ll face a 10% surcharge on your Part B premiums for each yearlong period you were eligible for coverage but failed to enroll.
2. Shop around during annual open enrollment
Each year, Medicare beneficiaries have the option to change their Part D drug plans or Medicare Advantage plans during open enrollment, which runs from Oct. 15 to Dec. 7. Be sure to explore your plan choices during that time because you may find that there’s a cheaper option than what you’re currently paying for.
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Also, both Part D plans and Advantage plans can change from year to year, so it’s important to compare your costs and coverage to what’s out there to make sure you’re getting the best deal, given your specific medications and needs.
3. Take advantage of the free care you’re entitled to
As a Medicare enrollee, you’re entitled to a host of free health services that it pays to capitalize on. In addition to an annual wellness checkup, you’re eligible for no-cost benefits such as alcohol counseling, depression screenings, flu shots, and other necessary diagnostic tests. It pays to take advantage of these free benefits because catching health problems early on could spare you more expensive healthcare bills down the line.
(Photo: Getty Images)
4. Look at Medicare Advantage
The one downside of Medicare Advantage is that it limits you to a specific network of providers. But from a cost perspective, you may find that you’re able to save a lot of money by switching from original Medicare to an Advantage plan.
Some Advantage plans charge a $0 premium, so there could be some savings in that regard (though you’ll still need to pay your Part B premiums even if you’re enrolled in Medicare Advantage).
Caroline Amenabar/NPR; Wil Taylor/Flickr
- Create a public option health care plan that expands off the Affordable Care Act.
- Decrease the price of prescription drugs.
- Protect abortion access.
- Invest $775 billion in child and elder care.
- Read details of Biden’s plans below.
- Repeal the Affordable Care Act and replace it with a new plan, which has not been publicly proposed.
- Lower the price of prescription drugs and insurance premiums.
- Read details of Trump’s plans below.
Biden’s plans for health care
Biden’s health care plan centers around reinforcing and expanding the Affordable Care Act — Obamacare — via a public option while also improving access to care.
The public option plan is described as available to all Americans, “whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether,” adding that the option is “like Medicare” — but is not Medicare.
The public option would be offered with no premiums to Americans who live in states that don’t have access to Medicaid benefits that they would qualify for in other states.
Though not explicitly mentioned in his proposal, Biden has said that undocumented immigrants would be able to buy into the public option plan and receive unsubsidized coverage — an option currently not allowed under the Affordable Care Act.
In terms of lowering costs on the individual health insurance marketplace, his proposal would do away with the “income cap” — which currently stands at 400% of the federal poverty line — that enables eligibility to receive a tax credit to help pay for premiums. The plan also would ensure that no household is putting more than 8.5% of their earnings (instead of the current 9.86%) into health insurance plans.
Biden’s proposal would work to lower prescription drug prices within Medicare, create an independent commission to oversee and regulate the price of new drugs, and get rid of the tax breaks given to pharmaceutical corporations on advertising.
On abortion access, Biden is in favor of restoring funding for Planned Parenthood. He does not support the so-called gag rule or the Hyde Amendment, which bans most federal funding for abortions. Biden backed the Hyde Amendment for a significant portion of his career and only came out against the legislation in July 2019, saying he could “no longer support an amendment that makes that right [to an abortion] dependent on someone’s ZIP code.”
Biden also wants to allocate $775 billion toward a plan for child and elder care. A lot of the funding would go toward cutting Medicaid waitlists for people needing home and community care, and to provide tax breaks to people who care for older family members.
Biden also pledges to invest in further health care employment, training 35,000 workers on how to aid Americans suffering from opioid addictions and adding “tens of thousands” of new jobs caring for veterans.
Biden also calls for the creation of a public health jobs corps, which would employ more than